Q: Texas teacher injured in a fall. TASB Risk Management does not have a specialist in network within 100 miles. Options?
I am a teacher/coach in Texas. I fell at practice and injured my back. Went to Urgent Care, x-rays negative, did conservative treatment which didn't work. Went back, MRI ordered and revealed multiple protruding disks and was referred to ortho spine specialist. He is no longer taking workers comp patients. The other spine specialist in network, and he has left the practice. No others within 100 miles. Was told by the adjuster that it is my responsibility to find a specialist that will be will ing to take TASB reimbursement. So far, none are willing. What are my options?
In addition, if I have to miss work for appointments related to injury, am I required to use my personal days?
A: You can contact the network administrator and ask for an out of network exception. Or else, you can drive to the network specialist and submit a milage request for reimbursment for a doctor that is over 30 miles from your home. I always try to make a written list of each doctor and/or medical provider that is unwilling to handle the case.
A: You can use your PCP or a referral from your PCP to a doctor when there are insufficient providers in the network. Good luck to you.
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